Neurofunctional differences and similarities between persistent postural-perceptual dizziness and anxiety disorder

• Published in: NeuroImage clinical Vol. 37; p. 103330
• Main Authors: Maywald, Maximilian, Pogarell, Oliver, Levai, Susanne, Paolini, Marco, Tschentscher, Nadja, Rauchmann, Boris Stephan, Krause, Daniela, Stöcklein, Sophia, Goerigk, Stephan, Röll, Lukas, Ertl-Wagner, Birgit, Papazov, Boris, Keeser, Daniel, Karch, Susanne, Chrobok, Agnieszka
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.01.2023; Elsevier
• Subjects: Anxiety - diagnostic imaging; Anxiety disorder; Anxiety Disorders - diagnostic imaging; Brain - diagnostic imaging; Cerebral Cortex; Dizziness - diagnostic imaging; fMRI; Humans; Persistent postural-perceptual dizziness; Radiology; Regular; Retroinsular cortex; Somatoform dizziness; Superior temporal gyrus; Supramarginal gyrus; Vertigo - diagnostic imaging; fMRI; Superior temporal gyrus; Supramarginal gyrus; Anxiety disorder; Somatoform dizziness; Retroinsular cortex; Persistent postural-perceptual dizziness
• ISSN: 2213-1582; 2213-1582
• DOI: 10.1016/j.nicl.2023.103330

•PPPD group showed increased neuronal activation in the supramarginal gyrus.•PPPD group showed increased neuronal activation in the superior temporal gyrus.•PPPD and ANX group showed similar neuronal activation patterns in the fear network.•Increased alexithymia scores in patients with persistent postural-perceptual dizziness.•PPPD and ANX group had similar scores for depression, anxiety and perception of illness. Persistent postural-perceptual dizziness (PPPD) (ICD-11) and anxiety disorders (ANX) share behavioural symptoms like anxiety, avoidance, social withdrawal, hyperarousal, or palpitation as well as neurological symptoms like vertigo, stance and gait disorders. Furthermore, previous studies have shown a bidirectional link between vestibulo-spatial and anxiety neural networks. So far, there have been no neuroimaging-studies comparing these groups. The aim of this explorative study was to investigate differences and similarities of neural correlates between these two patient groups and to compare their findings with a healthy control group. 63 participants, divided in two patient groups (ANX = 20 and PPPD = 14) and two sex and age matched healthy control groups (HC-A = 16, HC-P = 13) were included. Anxiety and dizziness related pictures were shown during fMRI-measurements in a block-design in order to induce emotional responses. All subjects filled in questionnaires regarding vertigo (VSS, VHQ), anxiety (STAI), depression (BDI-II), alexithymia (TAS), and illness-perception (IPQ). After modelling the BOLD response with a standard canonical HRF, voxel-wise t-tests between conditions (emotional-negative vs neutral stimuli) were used to generate statistical contrast maps and identify relevant brain areas (pFDR < 0.05, cluster size >30 voxels). ROI-analyses were performed for amygdala, cingulate gyrus, hippocampus, inferior frontal gyrus, insula, supramarginal gyrus and thalamus (p ≤ 0.05). Patient groups differed from both HC groups regarding anxiety, dizziness, depression and alexithymia scores; ratings of the PPPD group and the ANX group did differ significantly only in the VSS subscale ‘vertigo and related symptoms’ (VSS-VER). The PPPD group showed increased neural responses in the vestibulo-spatial network, especially in the supramarginal gyrus (SMG), and superior temporal gyrus (STG), compared to ANX and HC-P group. The PPPD group showed increased neural responses compared to the HC-P group in the anxiety network including amygdala, insula, lentiform gyrus, hippocampus, inferior frontal gyrus (IFG) and brainstem. Neuronal responses were enhanced in visual structures, e.g. fusiform gyrus, middle occipital gyrus, and in the medial orbitofrontal cortex (mOFC) in healthy controls compared to patients with ANX and PPPD, and in the ANX group compared to the PPPD group. These findings indicate that neuronal responses to emotional information in the PPPD and the ANX group are comparable in anxiety networks but not in vestibulo-spatial networks. Patients with PPPD revealed a stronger neuronal response especially in SMG and STG compared to the ANX and the HC group. These results might suggest higher sensitivity and poorer adaptation processes in the PPPD group to anxiety and dizziness related pictures. Stronger activation in visual processing areas in HC subjects might be due to less emotional and more visual processing strategies.